In recent decades a portentous cultural change has been gathering momentum in the
United States, giving rise to dangerous social and governmental developments. Increasingly,
Americans have embraced a therapeutic ethos. Actions previously understood
as irresponsible, imprudent, immoral, or even evil have come to be understood
as symptoms of underlying diseases that ought to be treated or cured rather than condemned
or punished. More and more people have been declared, or have declared
themselves, “victims.” They take themselves to be suffering, if only from hurt feelings,
because others—parents, schoolmates, coworkers, people at large—have somehow
infringed their asserted personal right to health and happiness. To a growing extent,
governments have become involved in “treating” these newly perceived ills, and in
doing so they have in effect asserted a novel raison d’être, a new justification for their
claims to legitimacy. Because the governments’ new claims to legitimacy have comported
so well with the public’s own understandings, little resistance has arisen to the
proliferating therapeutic programs at all levels of government.

James L. Nolan, Jr., has written an impressive and disturbing book about these
developments, The Therapeutic State: Justifying Government at Century’s End (New
York: New York University Press, 1998). Nolan’s study is conceptually well motivated
and empirically well validated; his presentation is soberly balanced and smoothly
written. Sociological research does not get much better than this. Notably, Nolan
concludes the study by considering the implications of the developing therapeutic
ethos for liberty, and he finds those implications unsettling.

The Therapeutic Ethos

Everyone will have noticed some aspect of the emerging therapeutic ethos. Where
once we had Alcoholics Anonymous and its twelve-step program, we now have countless
XYZ Anonymous groups, each with its own twelve-step remedy. No longer is
heavy drinking, cocaine use, or pummeling one’s spouse merely indicative of unwise
or cruel choices by the perpetrators; instead, such behavior is indicative of an underlying
disease. Hence it would be improper, even pointless, merely to censure or penalize the perpetrators. Rather, those who suffer from the diseases of alcoholism, drug addiction,
or violent abusiveness of a spouse should be treated, and a government operative
—a social worker, a judge, a public health doctor—is an appropriate agent to administer
the treatment. Along the way it will prove essential that the sufferer recognize
and admit that he has the disease. To do otherwise would be to remain “in denial,”
perhaps the most abominable and unacceptable condition in the eyes of those
who embrace the therapeutic ethos.

Sit Still, Johnny

In the new world of the therapeutic ethos, curing the children plays a leading part. In
olden days, some children chafed under the discipline and regimentation of the schools.
Some kids just wouldn’t sit still; others were downright naughty. No longer. Now they,
along with any others who fail to respond with zombie-like responsiveness to the school
regulations, are diagnosed as victims of attention deficit disorder (ADD). (Look it up.
The official guide is the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders, Third Edition, Revised [commonly called the DSM IIIR].)
For ADD, which “experts” believe afflicts 5 percent of all children, the prescribed
treatment is a drug called Ritalin. In some cases children have been refused admission to
schools, which the law requires them to attend (gotcha!), because their parents objected
to the children’s taking Ritalin. (Nolan cites Diane Divoky, “Ritalin: Education’s Fix-It
Drug,” Phi Delta Kappan 70 [April 1989]: 599–605.)

Build Self-Esteem

For an astonishingly wide spectrum of behaviors, adherents of the therapeutic ethos
view the underlying disease as itself the product of deficient self-esteem. To anyone
under the impression that the self-esteem movement is little more than another flaky
California fad, Nolan’s documentation will prove shocking. It seems that everything
from mathematical ineptitude to teen pregnancy to first-degree murder is now viewed
as stemming from insufficient self-esteem.

By the middle of 1994, some thirty states had enacted a total of over 170
statutes that in some fashion sought to promote, protect, or enhance the
self-esteem of Americans. The majority of these (around seventy-five) are,
not surprisingly, in the area of education. There are additionally at least
twenty self-esteem-related statutes in health care, over forty in welfare or
social services, and approximately sixteen in the area of corrections or criminal
justice. (Nolan, The Therapeutic State, p. 157)

Besides uncountably large numbers of touchy-feely Democrats, such prominent Republican
figures as Jack Kemp, Barbara Bush, and Colin Powell have come out in support
of the self-esteem movement.

Not to be outdone by the states, a number of federal government agencies have
issued regulations making reference to the building of self-esteem (Nolan, pp.
324– 26). Believe it or not, one such regulation was the Commerce Department’s
1986 “Northern Anchovy Fishery: Notice of Final Harvest Quotas” (51 FR
32334, cited by Nolan, p. 325). Is nothing sacred?

The Experts Tell Us . . .

In parallel with the spreading therapeutic ethos, psychologists have
established themselves as bona fide experts, and they have played an expansive
role as courtroom advocates of tort remedies for persons claiming to have
suffered emotional distress. Beginning in 1946 and ending in the 1970s, all the
states adopted licensing statutes for psychologists. “Often, state courts
justified the admittance of psychologists as expert witnesses on the basis of
the licensing statutes passed by their state legislature. Somehow licensing
codes gave credence to the idea that the psychologist was a legitimate expert”
(p. 70).

One upshot is that nowadays “therapeutic practitioners, with unprecedented
‘expert’ authority, provide the courts with psychologically inspired
interpretations about human behavior, motives, criminal activity, and
truthfulness” (p. 76). In such judicial proceedings “the state becomes
involved not only in the evaluation of behavior but in an assessment of the
internal processes of individual psyches” (p. 297).

Therapy Will Win the War (on Drugs)

State and federal prisons brim with persons convicted of drug offenses. Those
prisoners have become abundant grist for the mills of the therapeutic state. In
1962 the U.S. Supreme Court ruled that “states could compel offenders to
undergo drug treatment.” In 1966 the federal Treatment and Rehabilitation Act
“gave the courts statutory authority to commit drug offenders involuntarily to
residential and outpatient treatment programs as an alternative to
incarceration.” As Nolan remarks, “With these changes, the stage was set for
the conflation of criminal law and therapeutic drug treatment. A number of
organizations and agencies sprang up to fill this opening” (p. 81).

One such newcomer was the so-called drug courts, which have been established
in hundreds of jurisdictions across the country. Despite the failure of these
special courts to reduce recidivism, their popularity has grown merely because
of their approach, which is to treat drug offenses as pathological outcomes
rather than ordinary crimes. A drug court transforms a judge into a sort of
police-backed hyperintrusive schoolmarm who scolds, praises, or threatens the
“clients,” depending on how well they play along with the program (pp. 78–112,
295–96).

In 1966 the Narcotic Addict Rehabilitation Act required treatment for federal
drug convicts in prison, and by 1990 more than 218,000 prisoners were enrolled
in related counseling programs (p. 113). In the state prisons, by 1990, more
than 42 percent of the inmates were enrolled in a therapy or counseling program
of some sort (p. 115). Although the programs take various shapes, common threads
include “emphases on the primacy of self and the centrality of emotions, the
view of the inmate as a patient in need of healing, and the assumption that
abusive and victimized pasts predispose one toward crime” (p. 120). Not even
the get-tough-on-crime reaction of recent years has deflected the application of
the therapeutic ethos to the operation of the prisons.

Kid Stuff

In the schools, as in the prisons, the central objective is now to “cure”
the children by promoting their self-esteem. According to Rita Kramer, the
author of Ed School Follies, “Self-esteem has replaced understanding as
the goal of education” (quoted by Nolan, p. 150). One must admit that the
schoolteachers and counselors have had a large measure of success in their main
endeavor. Although in international comparisons American students rank very low
in math, science, and other educational attainments, they rank very high in
their own evaluation of their abilities (p. 169).

Although saving the children has long served to justify extraordinary
governmental measures, this rationale has become well-nigh universal in recent
years. Among the sacred cows of the child-savers, the Head Start program, begun
in 1964 as part of the War on Poverty, commands special veneration. Among other
achievements, Head Start gave rise to a program known as “Telephone Friends,”
allowing lonely old people to talk to young children on the telephone. According
to Congressman Ben Erdreich, this “truly gratifying endeavor” improved “self-worth
and self-esteem for both seniors and children alike” (quoted by Nolan, p.
216).

Nolan observes that “the state’s role toward children was viewed [in
Congressional debates] as most appropriate when some form of therapeutic
assistance was provided” (p. 217). That legislative perspective no doubt
contributed to the authorization of federal funding for Parents Anonymous (PA),
established in 1974. “Based on the self-help model of AA, the program provided
a forum where parents with the ‘sickness’ of child abuse could get help. Not
surprisingly, the help they sometimes needed was assistance in attaining a
higher view of the self” (p. 219). One wonders whether any member of Congress
has ever introduced a bill to establish Tenth Amendment Violators Anonymous (TAVA)—the
desperate need for such a group seems obvious.

Don’t Worry, It’s Good for You

Every smart ruler understands that the best kind of state coercion is the
kind that subjects do not regard as coercive. By resorting increasingly to just
that sort of coercion, American governments have succeeded in expanding into
whole new domains of private life while provoking scarcely a word of protest.

The ideals of a “scientifically” based, therapeutic understanding of
the world are so embedded in American culture that overt coercion is rarely
necessary. Instead, most citizens naturally comply with programs and policies
based on therapeutic rationales, because they are so “obviously”
plausible. The basic nature of the coercive and expanding state, then, has not
changed. What has changed is the source of legitimation by which the state
justifies its continued expansion—an expansion that, through use of
therapeutic symbols, can move into realms of societal life once left untouched
by the state. (p. 298)

Thus, while many freedom-loving citizens have been fighting the growth of
government at the front door—and even imagining that they are winning the
fight—governments at all levels have been streaming through the back door.
Having supposed that Orwell’s 1984 has been averted, people may yet wake up to
find themselves situated in Huxley’s Brave New World.